食管癌术中淋巴结化疗的临床研究

发布时间：2018-12-06 06:47

【摘要】：目的淋巴结转移是影响食管癌患者预后的主要因素。淋巴结化疗(lymph node chemotherapy,LNC)采用吸附了化疗药物的载体可被淋巴结中巨噬细胞吞噬的原理实现淋巴结的"靶向化疗"。本研究探讨LNC在食管癌术中的运用价值,筛选LNC中的较优药物,并与同期静脉化疗对比。方法选取2013-01-21-2013-10-23四川大学华西医院胸外科接受食管癌治疗的患者92例,采取单中心前瞻性半随机单盲对照研究。其中紫杉醇-纳米炭淋巴结化疗组(LNC by paclitaxel-carbon nanoparticles,LNP)、氟尿嘧啶-纳米炭淋巴结化疗组(LNC by fluorouracil-carbon nanoparticles,LNF)各41例,按相应药物接受术中LNC;氟尿嘧啶静脉化疗组(venous chemotherapy by fluorouracil,VF)10例,接受术中氟尿嘧啶静脉化疗。光镜下观察注射部位及淋巴结内药物分布,比较各组淋巴结、血清相应药物浓度。结果光镜下吸附了化疗药物的纳米炭未引起局部组织炎性细胞浸润及坏死,并可聚集于淋巴结皮质。LNP组淋巴结中紫杉醇药物浓度为2.16(3.25),高于血清浓度0.00(0.00),Z=-5.579,P0.01。LNF组淋巴结中氟尿嘧啶药物浓度为0.44(1.07),也高于血清浓度0.00(0.31),Z=-3.069,P0.01。而VF组淋巴结药物浓度0.11(0.26)与血药浓度0.00(0.15)的差异无统计学意义,Z=-0.135,P=0.893。LNF组淋巴结内药物浓度0.44(1.07)比VF组0.11(0.26)高,H=94.500,P0.01。LNP组淋巴结内药物浓度2.16(3.25)高于LNF组0.44(1.07),H=351.000,P0.01,血清药物浓度0.00(0.00)则低于LNF组0.00(0.31),H=577.000,P0.01。结论在食管癌术中,LNC可安全、有效地使化疗药物靶向进入并停留于淋巴结,在淋巴结转移疗效上可能优于同期静脉化疗。实施LNC时,优选对载体亲和力高的药物。
[Abstract]:Objective lymph node metastasis is a major prognostic factor in patients with esophageal cancer. Lymph node chemotherapeutic (lymph node chemotherapy,LNC (lymph node chemotherapy,LNC) uses the principle that the carrier of chemotherapeutic drugs can be phagocytized by macrophages in lymph nodes to realize the "targeted chemotherapy" of lymph nodes. The purpose of this study was to investigate the application value of LNC in esophageal cancer operation and to screen the better drugs in LNC, and to compare with intravenous chemotherapy at the same time. Methods Ninety-two patients with esophageal cancer received thoracic surgery in West China Hospital of Sichuan University, 2013-01-21-2013-10-23. A prospective, single-center, semi-randomized, single-blind controlled study was carried out. There were 41 cases of paclitaxel-nano-carbon lymph node chemotherapy group (LNC by paclitaxel-carbon nanoparticles,LNP) and 41 cases of fluorouracil nano-carbon lymph node chemotherapy group (LNC by fluorouracil-carbon nanoparticles,LNF). The patients received intraoperative LNC; according to the corresponding drugs. Ten patients in fluorouracil intravenous chemotherapy group (venous chemotherapy by fluorouracil,VF) received intraoperative fluorouracil intravenous chemotherapy. The distribution of drugs in the injection site and lymph nodes were observed under light microscope, and the corresponding drug concentrations in the lymph nodes and serum were compared. Results carbon nanoparticles adsorbed chemotherapeutic drugs under light microscope did not cause infiltration and necrosis of local inflammatory cells, and could be clustered in lymph node cortex. The concentration of paclitaxel in lymph nodes of LNP group was 2.16 (3.25). The concentration of fluorouracil was 0.44 (1.07) in the lymph nodes of ZHV 5.579 P0.01.LNF group, but also higher than that of 0.00 (0.31) in serum. In VF group, there was no significant difference in lymph node drug concentration between 0.11 (0.26) and 0.00 (0.15). The drug concentration in lymph nodes of P=0.893.LNF group was 0.44 (1.07) higher than that of VF group 0.11 (0.26). The intralymph node drug concentration of H94.500g P0.01.LNP group was 2.16 (3.25) higher than that of LNF group 0.44 (1.07). The serum drug concentration (0.00) was lower than that in LNF group (0.00 (0.31), P 0.01). Conclusion during esophageal cancer operation, LNC is safe and effective to make chemotherapeutic drugs enter and stay in lymph nodes, which may be superior to intravenous chemotherapy in lymph node metastasis. When implementing LNC, the drug with high affinity to the carrier was selected.
【作者单位】：四川大学华西医院胸外科;
【分类号】：R735.1

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